Exam 1 Flashcards
Key terms & concepts
Scope of practice
setting forth the services or activities that licensed professional are deemed competent and permitted to perform by state law; stipulates activities that nurses can and cannot perform legally
Standards of practice
explanatory statements that describe a competent level of care for all RNs
How is reciprocity applied in nursing licensure?
the ability to transfer current state license to another, providing the nurse has an initial nursing license and is in good standing
Which states participate in reciprocity?
All 50 states.
Self determination
the responsibility of each individual to act professionally within their role as a nurse
Policies and Procedures
governing rules and regulations established by institutions and organizations which direct nursing practice
Nurse Practice Act
Rules and regulations which are determined by each state to guide the delivery of nursing care to clients
Code of ethics
interpretive statements that address the values, client obligations, and ideals of the nursing profession
What are the five components of the Model of Professional Nursing Practice Regulation?
self determination, policies & procedures, nurse practice act, scope & standards of practice, code of ethics
Which organization created the Model of Professional Nursing Practice Regulation?
The ANA
National Academy of Medicine
nonprofit private business that provides objective data re: the health of society; emphasizes an evidence-based approach
National Student Nurses Association
nonprofit organization created for nursing students to provide an intro to professional development through conventions, networking, etc.
American Nurses Association (ANA)
key group for enhancing the nursing profession by encouraging elevated standards, promoting a work environment that is secure and ethical; lobbying for major issues
National League for Nursing (NLN)
organization that promotes excellence in nursing education to effectively build a strong and diverse nursing workforce that will advance health; core values = caring, integrity, D&I, and excellence
Who published the first “The Future of Nursing” report?
The Institute of Medicine (currently National Academy of Medicine)
What are the goals of “The Future of Nursing” report?
To increase the roles, responsibilities, and education of nurses to meet increased nursing demands by:
1) Increase BSN by 80%
2) Increase doctoral degrees by 100%
3) Allow APRNS to practice at full scope
4) Nurses in leadership roles for decisions + collaboration
5) Data systems
6) Diversity in hiring
What is the purpose of the National Academies of Medicine’s “Ending Unequal Treatment”
To address racial and ethnic inequities in health and healthcare and how that impacts well-being, premature death, and cost.
What does Healthy Nurse, Healthy Nation mean?
It is an initiative to promote healthy lifestyles for nurses by increasing rest, physical activity, quality of life, healthy eating, and safety
How do we address nursing shortages?
encouraging nurses to become educators
staffing
protecting safety & well-being
psychosocial support
prioritizing improvement of fair wages and working conditions
Health Promotion
empowering people to control and improve their physical and mental health
What is Healthy People 2030?
National goals to achieve better health for all Americans
Who created the Healthy People campaigns?
The US Office of Disease Prevention and Health Promotion (ODPHP)
Impaired Nursing
When alcohol or other substances are impairing the nurse’s ability to perform in personal or professional life
What are the 5 strategies to address the opioid epidemic?
(1) increased availability and access to Tx and recovery services
(2) greater use of overdose-reversing meds
(3) increased understanding of epidemic through better pub health ed and tracking
(4) support for research on pain and addiction
(5) improved and expanded practices for pain management
Structural Determinants of Health
Norms, policies, and institutions that define the social determinants of health
Oppression and structural racism include… (5)
(1) exploitation
(2) marginalization
(3) powerlessness
(4) cultural imperialism
(5) violence
Social determinants of health
How the environment that you live, work, play, age, etc. impacts a wide range of health, functioning, and quality of life outcomes and risks.
Why are non-healthcare sector partnerships important?
We must be equal partners and leaders in collaborating to address structural determinants of health
to improve Societal Commitment to Equity we need…
increased education for health professionals
effective curricula for how to address these issues
Cultural awareness
The ability and willingness to investigate and understand the differences between perception, belief, traditions, and values w/in the nurse’s own culture and those in other cultures
Cultural diversity
broad range of individual, population, and social characteristics (i.e., age, race, ethnicity, gender identity, geo location, language, SES, religion)
Cultural Competence
The ability to incorporate effective nursing care with emic and etic knowledge of different cultures
Emic
insider view of a culture
Etic
outsider view of a culture
Implicit bias
the involuntary attitudes or associations that affect our perceptions, actions, decisions, and interactions with others, unconsciously
Health Disparities
health outcomes that may be greater or lesser among different and other vulnerable client groups, compared to populations in the majority or dominant populations
What are cultural health assessments?
Types of data collection that can be conducted to gather information about the client’s culture and how it can affect their health
What three important aspects of using a medical interpreter?
1) Use a medical interpreter that is competent in the patient’s language
2) Address the patient and not the medical interpreter when communicating
3) Do not use family members as interpreters
What is Leininger’s Sunrise Enabler Framework?
Cultural assessment tool that is a visual portrayal of diff elements in the larger Theory of Culture Care Diversity and Universality
What is the purpose of Leininger’s Sunrise Enabler framework?
To provide a visual representation for healthcare provides to provide culturally congruent care and enhance health and well-being of all clients at all life stages
What is Category 1 of the Leininger’s Sunrise Enabler Model?
Cat 1: upper level - culture and social structure
What are the 3 modes of Care Decisions and Actions in Leininger’s Model?
(1) preservation and maintenance
(2) accommodation and negotiation
(3) repatterning and restructuring
Objective data
Information that can be observed by the nurse with their senses
Subjective data
Information that is collected through client’s feelings, perceptions, and assumptions
Cues
Things said or done that signal something; can be objective or subjective
Inference / Hypothesis
Well-informed guess of the client situation based on analyzing assessment data; can inform planning phase
Name 3 key considerations when a nurse is reporting and recording data
(1) report what is abnormal
(2) document patterns
(3) use quotes when possible
(4) concerns of patient/family
(5) strengths
What is nursing?
The diagnosis and tx of human responses; advocacy in the care of individuals, families, groups, communities, and population in recognition of the connection of all humanity.
What is a nursing diagnosis?
Diagnoses that nurses can give patients that guides the rest of the nursing process; concrete & evidence-based
NOC stands for
Nursing outcomes classification
NIC stands for
Nursing interventions classification
What is a medical diagnosis?
Made by a doctor or APRN; focuses on patient’s disease or medical condition, or pathologic state
What is the main model for spiritual assessment?
FICA
What does FICA stand for and what is it used for?
Stands for:
What is your FAITH or belief?
Is it IMPORTANT to you?
Are you part of a COMMUNITY?
How would you like me, as your nurse, to ADDRESS your spirituality or faith in my care?
Used for spiritual assessment
What does SMART stand for in SMART goals?
Specific, measurable, achievable, realistic, time-bound
Independent nursing interventions
Interventions initiated by nurses; do not need an order from another healthcare professional; autonomous decision, backed by scientific rationale
Dependent nursing interventions
Actions that require an order form another healthcare professional
Collaborative/interdependent interventions
Required combine knowledge/skill from multiple healthcare professionals
What is Category 2 of Leininger’s Model?
Cat 2: rays of sun - basic elements of the assessment
What is Category 3 of Leininger’s Model?
Cat 3: central core - interactions among the basic elements
What is Category 4 of Leininger’s Model?
Cat 4: focus on individuals, families, groups, communities in diverse health contexts
What is Category 5 of Leininger’s Model?
Cat 5: the 3 modes of Care Decisions and Actions
Critical thinking
Thought process that is systematic and logical in reviewing information and data, open to reflection, inquiry, and exploration in order to make informed decisions
What are the 6 steps of clinical judgment?
Recognize cues
Analyze cues
Prioritize hypotheses
Generate solutions
Take actions
Evaluate outcomes
Clinical judgment
the observed outcome of critical thinking and decision-making
Delegation
Assigning a nursing task or procedure to another person who has the training appropriate for that task or procedure
organizational skills
activities that allow the nurse to be efficient, accurate in delivering client care
what does SBAR stand for?
situation, background, assessment, recommendation
What does SOAP stand for?
subjective (data), objective (data), assessment, plan
What is the purpose of SBAR and SOAP?
They are tools to provide report on clients.
Client Assignments
process of dividing responsibility for care of multiple clients among the nursing staff
Acuity Level
The requirement of nursing services and the amount of nursing time to meet those requirements; complexity of a client’s condition
Direct Care Activities
Activities that require client contact
Indirect Care Activities
Activities that take a great deal of time but do not require direct interaction with the client
Direct assignments
Nurse is assigned to care for a specific client
Area assignments
Nurse is assigned to certain zone and care for the clients who temporarily reside there
Group assignments
Nurse is assigned to a certain group of clients who have been sorted together
Group assignments are useful on units with ____ client census
larger
Discharge Planning
Procedure to determine what additional support a client needs in order to be transferred from one care facility to another, or home
What does IDEAL stand for?
I - Include
D - Discuss (the 5 key areas)
E - Educate the client
A - Assess (if ed was effective)
L - Listen to client’s goals and preferences
Teach back
A technique to determine the client’s level of understanding by having the client explain back to the nurse the info that was taught
What are the five rights of delegation?
Right task, right circumstance, right person, right directions & communication, right supervision & evaluation
Managing a group of clients
Nursing process of organizing delivery of clients’ care tasks among a group of people
Team nursing
Two or more nurses paired together as a team to care for a group of clients
What does STAMP stand for?
Staring, Tone and volume of voice, Anxiety, Mumbling, and Pace
Name three effective strategies for the nurse to be safe in a potentially abusive situation
(1) Speak in a calm tone of voice
(2) Minimize noise
(3) Keep a barrier between the nurse and the client
What is the purpose of a Certification?
for nurses to demonstrate additional skills in a specialty area
Name 3 benefits of a Certification
(1) Increases client satisfaction
(2) Reduces risk of errors
(3) Can increase salary or offer promotion
Who created the concept of Health Promotion?
the WHO
What are the 5 categories of health promotion?
(1) Establish health policies that support healthy lifestyles
(2) Provide education to empower personal health skills
(3) Build a culture of support
(4) Build strong community resources
(5) Build a holistic healthcare system
What is NANDA?
Governing body for the nursing community that makes decisions on nursing diagnoses
What is the role of an licensed practical nurse (LPN)?
They can do everything a CNA can do including wound care and administer medications. They must be supervised by a nurse and have a training program (usually college level or tech, 10 months-1 year) and must pass the NCLEX-PN.
What is the role of a certified nursing assistant (CNA)?
They are an assistant to a nurse who can take vitals, help with mobility, feeding, and bathing. They must go through a training program and must be supervised by an RN or LPN. Must be 16 years or older.
What is the role of a registered nurse (RN)?
Nurses can do everything a CNA and LPN can do including tasks that require clinical judgement and decision making, physical exams, health history, health promotion, education, medication admin, and coordination of care.
They must pass the NCLEX-RN.
What is the role of an advanced practice registered nurse (APRN) and what are the 4 licenses for APRNS?
They can do everything an RN can including specialized tasks such as prescribing medications to administering anesthesia.
1) nurse practitioner (CNP); 2) certified nurse-midwife (CNM); 3) clinical nurse specialist (CNS); 4) certified registered nurse anesthetist (CRNA)
What is Benner’s Novice to Expert Framework?
It is a framework that describes how a noivce nurse develops nursing knowledge, skills, clinical competence, and comprehension of patient care to become an expert. It’s is dependent on clinical experience and length of time in profession.
Novice, advanced beginner, competent, proficient, expert
Concept
Building blocks of a theory; provide a mental image
Propositions
Statements of the relationship between 2 or more concepts that provides a theory with the ability to describe, explain, or predict
Theory
set of interrelated concepts, based on assumptions, built on propositional statements
What are the 5 categories in Kristen Swanson’s Theory of Caring?
(1) Knowing
(2) Being with
(3) Doing for
(4) Enabling
(5) Maintaining belief
Name the three types of theories
Grand, middle, and micro
Which theory types can be used for nursing research?
Middle and micro theories
Name the 4 parts of the nursing’s standard paradigm
person, nursing, health, environment
Evidence-based practice
The process of using evidence from credible scientific research to guide nursing interventions and clinical judgment.
Florence Nightingale contributions
hygiene, documentation, evidence-based practice, data collection
Who started the American Red Cross?
Clara Barton
What was Dorothea Dix best known for?
Advocacy for mental health and indigenous rights
What are the 6 key roles of a nurse?
Change agent, advocate, care provider, case manager, researcher, educator
Name 4 responsibilities of a nurse manager
Budgeting, resolving conflicts, scheduling, client safety
Provides an explanation and suggested course of action when there is a change in practice, practice concerns, or a topic related to nursing that needs to be addressed
ANA Position Statement
Identifies where, when, why, and how nursing occurs and the actions that all nurses are expected to perform competently
Nursing Scope and Standards of Practice
ANA Principles for Nursing Practice
Provides practice info regarding issues such as social media, staffing, and pay for nursing staff
Code of Ethics for Nurses
Identifies behaviors and practices nurses should abide by to provide quality, ethical care
Name 3 roles for nurses in telehealth
(1) program development
(2) direct pt and family care
(3) collaboration with healthcare providers
State Nurse Practice Acts
current laws and regulations governing nursing practice in every state and territory of the United States
Who must approve a nursing program before the school can open for enrollment?
State Board of Nursing (BON)
Set of nursing competencies and proposed targets for the knowledge, skills, and attitudes that all prelicensure nursing students should have attained for entry to practice.
Quality and Safety Education for Nursing (QSEN)
What are the Bachelor of Science in Nursing Essentials?
10 domains that encompass the essentials that outline the expected curriculum content and required competencies that graduates from a baccalaureate program should have
The National Council of State Boards of Nursing (NCSBN) has identified what problem?
New nurses are struggling to transition into nursing after school is over.
What is the NCSBN Transition to Practice (TTP) model?
Program to reinforce new skills and knowledge of the graduate nurse with a preceptor
Name the 4 steps in the practical nurse process.
Data collection, planning, implementation, evaluation
Licensure
The method by which the BONs authorize an individual to practice nursing within a specific scope of practice
Credentialing
Process that provides confirmation of an individual’s abilities to practice as a health professional
What is the correct order of credentials after your name?
Education (MSN), Licensure (RN), Certification (OCN)
The extent to which an individual can obtain, process, and comprehend basic health information is called?
Personal Health Literacy
The extent to which organizations equitably assist individuals with understanding, finding, and using info to make informed health decisions is called?
Organizational Health Literacy
What does ADOPIE stand for?
Assessment, Diagnosis, Outcomes, Planning, Implementation, Evaluation
Validation of data means…
The comparison of data with another source to determine data accuracy
Food and fluid intake is an example of what?
Nursing Outcomes Classification (NOC)
What is the difference between NOC and client outcomes?
NOC is broad; client outcomes are much more specific.
Client outcomes should be…
patient-centered, singular, SMART, mutual
What are the three skills needed for implementing nursing interventions?
Cognitive, interpersonal, psychomotor skills
T/F - once you start a care plan, you cannot modify it.
False. You SHOULD modify the care plan if it’s not achieving the outcomes you are aiming to achieve.
OAS, BVC, and BRACHA all help to assess what?
Clients who are at risk of being abusive
What are Maslow’s 5 Needs?
(1) physiological
(2) safety
(3) love and belonging
(4) self-esteem
(5) self-actualization
Which of Maslow’s needs are deficiency needs?
physiological, safety, love & belonging, and self-esteem
What does ABCDE stand for?
Airway
Breathing
Circulation
Disability
Exposure
the nurse must be aware of both expected and unexpected findings for each system to use which prioritization method?
ABCDE
Name two ways to assess airway
Listen for breath sounds
If the client can talk
How do you assess breathing?
Auscultate the lungs
RR
Cyanosis
Thoracic wall symmetry
How do you assess for circulation?
Cap refill
Pulse Rate
BP
LOC
changes in skin tone
urine output
How do you assess disability?
Assess the client’s neurologic status
What are you looking for when assessing Exposure?
Internal or external bleeding
DVTs
Rashes
Temperature
What is the goal of client safety measures?
To decrease risks and errors that might potentially occur during the delivery of health care
Safety & Risk Reduction Framework
Places priority on the situation that will put the client at the greatest safety risk
Least Restrictive/Least Invasive Framework
Interventions are selected that maintain client safety while producing the least amount of restriction to the client; the nurse chooses interventions that are the least invasive.
Priority is given to the client who has a reasonable chance of survival with immediate intervention. This framework is typically used in situations where resources are limited, such as with mass casualties and disaster triage.
Survival Potential Framework
Resource Allocation
The distribution of resources to a service or department.
Emergent or Immediate category is what color?
Red
What does Emergent or Immediate mean for a client?
They need attention immediately but also have a good chance of survival
Urgent or Delayed category is what color?
Yellow
What does Urgent or Delayed mean for a client?
Clients have a serious injury but it does not have a direct threat on their life.
Nonurgent or Minimal category is what color?
Green
What does nonurgent or minimal mean for a client?
The client has minor injuries that do not need to be ASAP addressed
Expectant category is what color?
Black
What does Expectant mean for a client?
Clients who are either deceased or not likely to survive
What does Acute vs Chronic Framework prioritize?
Acute conditions are prioritized over chronic.
What does Urgent vs Non-Urgent prioritize?
Clients with urgent needs are prioritized over clients with non-urgent needs.
What two factors make tasks unable to be delegated?
Any tasks that require:
1) Decision making
2) Clinical judgement
What is spiritual distress?
A state of suffering related to the impaired ability to integrate meaning and purpose in life through connections with self, others, or a superior being
Is spiritual assessment required upon history taking?
Yes, the Joint Commission mandates that spiritual assessments are performed and documented.
What does RAPSAE stand for?
R - Recognize cues
A - Analyze
P - Prioritize hypothesis
S - Sugget solutions
A - Act
E - Evaluate outcome
What is clinical reasoning?
Diagnostic reasoning combined with clinical judgement
At this stage, nurses have no background practical experience, only theoretical knowledge. Which stage is this?
Novice
Nurses that focus on completing all ordered treatments and procedures, not on individualized care are at what stage in Benner’s theory?
Advanced Beginner
At the ____ stage, nurses devise new procedures and develop new clinical knowledge; more focus on individualized care
Competent
At the ___ stage, nurses demonstrate abilities for changing situations; take clinical leadership when needed
Proficient
Nurses who act in a fluid automatic manner are in what stage?
Expert
Nurturing way of relating to a valued other whom you feel a sense of personal commitment towards
Definition of Caring
The fundamental belief that someone will get through the current events and transitions they are enduring
Maintaining belief
Knowing refers to what?
The clinical skills and knowledge; level of competency that you can deliver to the client
Mutual trust, faithfulness, emotional availability, and patience are traits of which stage of the Theory of Caring?
Being with
The unique function of a nurse to execute on the behalf of the client when needed
Doing for
Facilitating the other’s passage through life stages; providing a sense of self-healing
Enabling
name the 5 external forces of SDOH
structural determinants of health
oppression and structural racism
SDOH
non-healthcare sector partnerships
societal commitment to equity
